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Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG
Nicholas S Abend1, Shavonne L Massey, Mark Fitzgerald
1Departments of *Neurology, †Pediatrics, and ‡Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.; and §Center for Clinical Epidemiology and Biostatistics, Philadelphia, Pennsylvania, U.S.A.
Insights
Standardized EEG terminology shows high agreement for interpreting EEGs in critically ill children after cardiac arrest. This supports its use for neuroprognostication studies.
Area of Science:
- Pediatric critical care neurology
- Neurophysiology
- Electroencephalography (EEG) interpretation
Background:
- Accurate EEG interpretation is crucial for neuroprognostication in critically ill children.
- Standardized terminology aims to improve consistency in EEG analysis.
- Previous studies highlight variability in EEG interpretation among clinicians.
Purpose of the Study:
- To evaluate interrater agreement of EEG interpretation using standardized terminology.
- To assess the reliability of the American Clinical Neurophysiology Society's (ACNS) Standardized Critical Care EEG terminology.
- To determine the effectiveness of standardized EEG interpretation in critically ill children post-cardiac arrest.
Main Methods:
- Four pediatric electroencephalographers reviewed 10-minute EEG segments from 72 children.
- Recordings were obtained 24 hours after return of circulation following cardiac arrest.
- Analysis used the ACNS Standardized Critical Care EEG terminology, calculating agreement for individual variables and a composite background category.
Main Results:
- Almost perfect agreement was observed for the overall background EEG category (kappa 0.89) and seizures (kappa 0.93).
- Substantial agreement was found for continuity (kappa 0.79) and voltage (kappa 0.70) variables.
- Moderate to fair agreement was noted for other variables, with improved consistency when variable options were condensed.
Conclusions:
- The standardized EEG terminology and composite background category demonstrate strong interrater reliability.
- These findings support the use of standardized EEG interpretation for neuroprognostication research in pediatric cardiac arrest survivors.
- Further research can build upon this standardized framework to enhance EEG analysis in critical care settings.
Purpose:
We evaluated interrater agreement of EEG interpretation in a cohort of critically ill children resuscitated after cardiac arrest using standardized EEG terminology.
Methods:
Four pediatric electroencephalographers scored 10-minute EEG segments from 72 consecutive children obtained 24 hours after return of circulation using the American Clinical Neurophysiology Society's (ACNS) Standardized Critical Care EEG terminology. The percent of perfect agreement and the kappa coefficient were calculated for each of the standardized EEG variables and a predetermined composite EEG background category.
Results:
The overall background category (normal, slow-disorganized, discontinuous, or attenuated-featureless) had almost perfect agreement (kappa 0.89).The ACNS Standardized Critical Care EEG variables had agreement that was (1) almost perfect for the seizures variable (kappa 0.93), (2) substantial for the continuity (kappa 0.79), voltage (kappa 0.70), and sleep transient (kappa 0.65) variables, (3) moderate for the rhythmic or periodic patterns (kappa 0.55) and interictal epileptiform discharge (kappa 0.60) variables, and (4) fair for the predominant frequency (kappa 0.23) and symmetry (kappa 0.31) variables. Condensing variable options led to improved agreement for the continuity and voltage variables.
Conclusions:
These data support the use of the standardized terminology and the composite overall background category as a basis for standardized EEG interpretation for subsequent studies assessing EEG background for neuroprognostication after pediatric cardiac arrest.
